ABSTRACT
OBJECTIVE: To investigate the effects of high-intensity aerobic exercise on adrenocortical responsiveness and on standard outcome measures in patients with chronic low back pain. DESIGN: Controlled clinical trial. SETTING: Physical therapy department of a university general hospital. SUBJECTS: Sixty-four patients with chronic low back pain were randomly allocated into positive and negative suppression test groups and assigned to exercise protocol. INTERVENTIONS: Subjects in the positive and negative dexamethasone suppression test groups received a 12-week high-intensity aerobic exercise programme. MAIN OUTCOME MEASURES: Dexamethasone suppression test as an index of adrenocortical responsiveness, pain measured with the McGill Pain Questionnaire, functional status measured with the Roland Morris Disability Questionnaire, and psychological strain measured with the Hospital Anxiety and Depression Scale. RESULTS: Data analysis in the positive group identified a significant reduction of pain by 30% (t(30) = 11.2, P<0.001), a recovery of the lost functioning by 34% (t(30) = 19.7, P<0.001), a reduction of anxiety/depression by 25% (t(30) = 10.2, P<0.001), and a change in adrenocortical responsiveness by 40% (t(30) = 14.1, P<0.001). In the dexamethasone suppression test negative group, data analysis identified a significant reduction of pain by 8% (t(31) = 4.2, P<0.001), a recovery of lost functioning by 10% (t(31) = 4.8, P<0.001), a reduction of anxiety/depression by 11% (t(31) = 5.0, P<0.001), and no change in adrenocortical responsiveness (t(31) = 1.2, P=0.22). In univariate analysis between-subject differences were significant for dexamethasone suppression test (F(61) = 163, P<0.001), and for anxiety/depression (F(61) = 21.3, P<0.001). CONCLUSION: Exercise alleviated pain, functional disability and anxiety/depression, also improved adrenocortical responsiveness in patients with chronic low back pain with dexamethasone suppression test positive values.
Subject(s)
Adrenal Cortex/physiopathology , Exercise/physiology , Low Back Pain/physiopathology , Low Back Pain/rehabilitation , Adrenal Cortex/physiology , Adrenal Cortex Function Tests , Adult , Aged , Anxiety/diagnosis , Anxiety/metabolism , Chronic Disease , Depression/diagnosis , Depression/metabolism , Dexamethasone/administration & dosage , Female , Humans , Hydrocortisone/metabolism , Low Back Pain/metabolism , Low Back Pain/psychology , Male , Middle Aged , Pain Measurement , Treatment OutcomeABSTRACT
BACKGROUND: Prechtl's method on the qualitative assessment of general movements (GMs) is a powerful tool for early and specific prediction of cerebral palsy. However, it is uncertain whether the GM assessment can be used to predict mild neurological impairment. AIMS: To determine whether the quality of general movements (GMs) from the age of 3 to 5 months, i.e. fidgety movements, is related to the presence of complex minor neurological dysfunctions (MND) 13 to 15 years later. STUDY DESIGN: Prospectively collected data on the quality of GMs during infancy were retrospectively analysed on the basis of MND at puberty. SUBJECTS: Twenty-eight participants (14 girls and 14 boys) with a median gestational age of 40 weeks (range: 35 to 42 weeks) and an appropriate birth weight (median 3390 g; range 1900 to 4200 g). OUTCOME MEASURES: Touwen's neurological examination. RESULTS AND CONCLUSIONS: Abnormal fidgety movements were not related to later complex MND, but to fine manipulative disabilities (p<0.05). Normal fidgety movements, which are continually present in the whole body, might be required for optimal calibration of the proprioceptive system.
